A new USC leadership study using functional magnetic resonance imaging (FMRI) reveals the nerve mechanisms that contribute to urinary incontinence, a common condition that affects the survivors of the stroke that has a significant impact on their quality of life.
The survey has just been published in RapIt was conducted by a multi -scientific team of urologists, neurosurgeons and imaging experts by the USC Keck Medicine, the USC National Rehabilitation Center and Shirley Ryan Able Lab. The group discovered significant differences in brain activity during volunteers against unintentional bladder contractions, presenting possible paths for targeted treatments.
Urine incontinence affects up to 79% of patients immediately after almost 49% in almost 40% of survivors a year later. It usually results from uncontrolled bladder contractions and unintentional urinary expulsion, leaving patients with debilitating symptoms such as urinary need, frequency and leak. Although common, it is often treated. This situation also predicts poorer in the long term, including higher mortality rates and increased disability.
The brain plays a decisive role in regulating the bladder, allowing people to feel the full bladder and enable them to delay urination until they are socially appropriate or start at will. On the contrary, stroke survivors often struggle to suppress the unwanted bladder contractions and may even completely lose the bladder. Since a stroke affects the brain, it disrupts the normal pathways that govern the control of the bladder. However, the exact neurological foundations of this malfunction remained badly understood until recently. ”
Evgeniy Kreydin, MD, Assistant Assistant Professor of Clinical Urology and Head of Study Author
This research played a key role in Kreydin, which received the McGuire-Zimskind Award from the Urodynamic, Pelic Medicine and Urogennetic Reconstruction Company (SUFU). The award honors early career professionals within ten years of the completion of the stay or scholarship that have contributed significantly to the field through basic and clinical research. The study used an innovative method of repeated filling and canceling the bladder, while the participants were in the magnetic resonance imaging, during which their brain function was measured.
“Unlike previous studies where the participants using a catheter entered the scanner with a full bladder and were canceled by order, our study allowed us to observe the filling and cancellation repeatedly. served as an expert for the study.
During the voluntary bladder evacuation, when participants consciously decided to empty the bladder, both healthy individuals and stroke survivors showed significant activation in brain -related brain -related areas. On the contrary, the unintentional or acoustic or acoustic bladder that is evacuated in stroke survivors were characterized by minimal activation of the crust, indicating failure to engage in basic brain networks necessary for urine control.
In both healthy individuals and stroke survivors, the filling of the bladder before voluntary urination caused activity in a collection of brain areas known as the Salience network. These areas of the brain work together to evaluate the importance of internal or external stimuli and to coordinate brain response to these stimuli. However, during the filling of the bladder that preceded the unintentional urination, this network remained inactive for a stroke with incontinence. These findings indicate that the inability to participate in the Salience network can be a key mechanism that is the basis of urinary incontinence after the stroke.
These findings open the doors for new interventions aimed at restoring bladder control in patients with stroke. Possible therapeutic approaches could include:
- Using non -invasive brain stimulation techniques, such as transnational magnetic stimulation (TMS) or instant current stimulation (TDCS), to target the Salience network
- Development of drugs that enhance nerve activation in critical contrasting areas
- Cognitive training and biofeedback treatments aimed at improving bladder awareness and voluntary control
While the study represents a significant progress in understanding incontinence after the stroke, the researchers underline the need for further research. Future studies could explore the way different types of strokes affect urine control and if the timely intervention aimed at the Salience network can help prevent chronic incontinence in the stroke survivors.
Charles Liu, PhD, MD, director of USC’s Neurorestoration Center, a senior author of the study and coordinator of all partners, is promising for further discovery, as this important research is based. “The neurological basis of urination is still slightly understood and additional research will be vital to urinary and reproductive systems,” said Liu, who is also a professor of clinical neurological surgery, surgery, surgery and surgery. “This project not only deepens our understanding of a common complication after the stroke, but it also provides hope for a better quality of life for millions of stroke survivors worldwide.”
This study was funded by a grant by the Urology Foundation at Evgeniy Kreydin. The authors include Evgeniy I. Kreydin, MD, Aidin Abedi, MD, Luis Morales, MD, Stefania Montero, MD, Priya Kohli, BS, NHI HA, BS, David Chapman, MD, Armita Abedi, MD, David, MD, MD, MD, Kay, Kay Jann, PhD L. Harvey Liu, MD, Phd.
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